La recherche en sciences sociales met en lumière l’importance croissante des grands défis sociétaux, tels que le réchauffement climatique ou le vieillissement de la population. Ces défis complexes, qui évoluent dans le temps, nécessitent une approche multidisciplinaire, intégrant des aspects technologiques et sociaux. Les politiques publiques traditionnelles sont souvent inadaptées à ces défis pernicieux, nécessitant une transformation vers des politiques d’innovation orientées vers des missions, où les objectifs sociaux et environnementaux guident les efforts d’innovation. Cette approche implique une collaboration entre acteurs publics, privés et non lucratifs, ainsi qu’une participation inclusive de toutes les parties prenantes. L’innovation, autrefois perçue comme un moteur de progrès, est aujourd’hui source de certaines critiques. Les politiques d’innovation doivent donc évoluer vers une approche plus réfléchie, inclusive et flexible, centrée sur la résolution collective de problèmes pernicieux, avec une attention particulière portée à l’engagement des parties prenantes et à la responsabilité sociale de l’innovation. Codes JEL : O30, O35, O38
{"title":"Grands Challenges et politiques publiques d’innovation : un état des lieux","authors":"I. Liotard, Valérie Revest","doi":"10.3917/inno.074.0005","DOIUrl":"https://doi.org/10.3917/inno.074.0005","url":null,"abstract":"La recherche en sciences sociales met en lumière l’importance croissante des grands défis sociétaux, tels que le réchauffement climatique ou le vieillissement de la population. Ces défis complexes, qui évoluent dans le temps, nécessitent une approche multidisciplinaire, intégrant des aspects technologiques et sociaux. Les politiques publiques traditionnelles sont souvent inadaptées à ces défis pernicieux, nécessitant une transformation vers des politiques d’innovation orientées vers des missions, où les objectifs sociaux et environnementaux guident les efforts d’innovation. Cette approche implique une collaboration entre acteurs publics, privés et non lucratifs, ainsi qu’une participation inclusive de toutes les parties prenantes. L’innovation, autrefois perçue comme un moteur de progrès, est aujourd’hui source de certaines critiques. Les politiques d’innovation doivent donc évoluer vers une approche plus réfléchie, inclusive et flexible, centrée sur la résolution collective de problèmes pernicieux, avec une attention particulière portée à l’engagement des parties prenantes et à la responsabilité sociale de l’innovation. Codes JEL : O30, O35, O38","PeriodicalId":80004,"journal":{"name":"Innovations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141373079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-16DOI: 10.1177/15569845241238000
Antonios Pitsis
{"title":"Totally Endoscopic Triple-Valve Surgery With Transcatheter Valve in Mitral Annular Calcification, Aortic Valve Replacement, and Tricuspid Repair.","authors":"Antonios Pitsis","doi":"10.1177/15569845241238000","DOIUrl":"https://doi.org/10.1177/15569845241238000","url":null,"abstract":"","PeriodicalId":80004,"journal":{"name":"Innovations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140697686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-15DOI: 10.1177/15569845241239448
Joseph Zacharias, M. Glauber, Antonios Pitsis, M. Solinas, Jorg Kempfert, Mario Castillo-Sang, H. Balkhy, Patrick Perier
{"title":"The 7 Pillars of Starting an Endoscopic Cardiac Surgery Program.","authors":"Joseph Zacharias, M. Glauber, Antonios Pitsis, M. Solinas, Jorg Kempfert, Mario Castillo-Sang, H. Balkhy, Patrick Perier","doi":"10.1177/15569845241239448","DOIUrl":"https://doi.org/10.1177/15569845241239448","url":null,"abstract":"","PeriodicalId":80004,"journal":{"name":"Innovations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140702050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.1177/15569845241239911
Yazan Aljamal, Hiroto Kitahara, Blaine Johnson, Kaitlin Grady, H. Balkhy
OBJECTIVE Femoral artery cannulation is the most commonly used approach for cardiopulmonary bypass (CPB) in robotic cardiac procedures. However, without adding a distal perfusion cannula, leg ischemia can occur in up to 11.5% of patients. There is a well-described 2 to 4 mm size arterial branch that originates from the medial side of the external iliac artery or inferior epigastric artery, immediately above the inguinal ligament, and connects to the obturator artery. Therefore, it was historically named the corona mortis, which means "crown of death" in Latin. When peripheral cannulation is performed above this branch in the external iliac artery, we consider it a corona "vitae" because of its role as a limb-saving collateral. We report herein our standard technique of peripheral cannulation without the need of a distal perfusion cannula and preventing limb ischemia. METHODS We included all patients who underwent robotic cardiac surgery with peripheral cannulation over a 16-month period at our institution. We cannulated just above the level of the inguinal ligament through a 2 to 3 cm transverse skin incision. The incidence of limb ischemia and vascular complications was recorded and analyzed. RESULTS During the study period, 133 patients underwent robotic cardiac procedures with peripheral "external iliac" CPB. The size of the cannula was 21F or larger in 73% and 23F in 54% of the patients. No leg ischemia or femoral artery complications requiring additional intervention occurred. CONCLUSIONS External iliac cannulation can be successfully performed in robot-assisted cardiac surgery using relatively large cannulas without the need of a distal limb perfusion catheter, with good results. In our view, given the importance of the corona mortis ("crown of death" in Latin) in perfusing the limb during CPB, we propose a new name for this artery in robotic cardiac surgery, namely, the corona vitae ("crown of life" in Latin).
{"title":"Routine External Iliac Artery Cannulation in Robotic Cardiac Surgery: Role of the Corona \"Vitae\" in Distal Limb Perfusion.","authors":"Yazan Aljamal, Hiroto Kitahara, Blaine Johnson, Kaitlin Grady, H. Balkhy","doi":"10.1177/15569845241239911","DOIUrl":"https://doi.org/10.1177/15569845241239911","url":null,"abstract":"OBJECTIVE\u0000Femoral artery cannulation is the most commonly used approach for cardiopulmonary bypass (CPB) in robotic cardiac procedures. However, without adding a distal perfusion cannula, leg ischemia can occur in up to 11.5% of patients. There is a well-described 2 to 4 mm size arterial branch that originates from the medial side of the external iliac artery or inferior epigastric artery, immediately above the inguinal ligament, and connects to the obturator artery. Therefore, it was historically named the corona mortis, which means \"crown of death\" in Latin. When peripheral cannulation is performed above this branch in the external iliac artery, we consider it a corona \"vitae\" because of its role as a limb-saving collateral. We report herein our standard technique of peripheral cannulation without the need of a distal perfusion cannula and preventing limb ischemia.\u0000\u0000\u0000METHODS\u0000We included all patients who underwent robotic cardiac surgery with peripheral cannulation over a 16-month period at our institution. We cannulated just above the level of the inguinal ligament through a 2 to 3 cm transverse skin incision. The incidence of limb ischemia and vascular complications was recorded and analyzed.\u0000\u0000\u0000RESULTS\u0000During the study period, 133 patients underwent robotic cardiac procedures with peripheral \"external iliac\" CPB. The size of the cannula was 21F or larger in 73% and 23F in 54% of the patients. No leg ischemia or femoral artery complications requiring additional intervention occurred.\u0000\u0000\u0000CONCLUSIONS\u0000External iliac cannulation can be successfully performed in robot-assisted cardiac surgery using relatively large cannulas without the need of a distal limb perfusion catheter, with good results. In our view, given the importance of the corona mortis (\"crown of death\" in Latin) in perfusing the limb during CPB, we propose a new name for this artery in robotic cardiac surgery, namely, the corona vitae (\"crown of life\" in Latin).","PeriodicalId":80004,"journal":{"name":"Innovations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-11DOI: 10.1177/15569845241241534
H. Kirov, T. Caldonazo, Angelique Runkel, J. Fischer, P. Tasoudis, M. Mukharyamov, G. Cancelli, Michele Dell'Aquila, Torsten Doenst
OBJECTIVE Minimally invasive cardiac surgery (MICS) is increasing worldwide. In most cases, the surgical technique includes cannulation of the groin for the establishment of cardiopulmonary bypass, requiring a second surgical incision (SC) for exposure and cannulation of the femoral vessels. With the introduction of arterial closure devices, percutaneous cannulation (PC) of the groin has become a possible alternative. We performed a meta-analysis and systematic review to compare clinical endpoints between the patients who underwent PC and SC for MICS. METHODS Three databases were assessed. The primary outcome was any access site complication. Secondary outcomes were perioperative mortality, any wound complication, any vascular complication, lymphatic complications, femoral/iliac stenosis, stroke, procedural duration, and hospital length of stay (LOS). A random effects model was performed. RESULTS A total of 5 studies with 2,038 patients were included. When compared with PC, patients who underwent SC showed a higher incidence of any access site complication (odds ratio [OR] = 3.09, 95% confidence interval [CI]: 1.87 to 5.10, P < 0.01), any wound complication (OR = 10.10, 95% CI: 3.31 to 30.85, P < 0.01), lymphatic complication (OR = 9.37, 95% CI: 2.15 to 40.81, P < 0.01), and longer procedural duration (standardized mean difference = 0.31, 95% CI: 0.12 to 0.51, P < 0.01). There was no significant difference between the 2 groups regarding perioperative mortality, any vascular complication, femoral/iliac stenosis, stroke, or hospital LOS. CONCLUSIONS The analysis suggests that surgical groin cannulation in MICS is associated with a higher incidence of any access site complication (especially wound complication and lymphatic fistula) and with a longer procedural time compared with PC. There was no difference in perioperative mortality.
{"title":"Percutaneous Versus Surgical Femoral Cannulation in Minimally Invasive Cardiac Surgery: A Systematic Review and Meta-Analysis.","authors":"H. Kirov, T. Caldonazo, Angelique Runkel, J. Fischer, P. Tasoudis, M. Mukharyamov, G. Cancelli, Michele Dell'Aquila, Torsten Doenst","doi":"10.1177/15569845241241534","DOIUrl":"https://doi.org/10.1177/15569845241241534","url":null,"abstract":"OBJECTIVE\u0000Minimally invasive cardiac surgery (MICS) is increasing worldwide. In most cases, the surgical technique includes cannulation of the groin for the establishment of cardiopulmonary bypass, requiring a second surgical incision (SC) for exposure and cannulation of the femoral vessels. With the introduction of arterial closure devices, percutaneous cannulation (PC) of the groin has become a possible alternative. We performed a meta-analysis and systematic review to compare clinical endpoints between the patients who underwent PC and SC for MICS.\u0000\u0000\u0000METHODS\u0000Three databases were assessed. The primary outcome was any access site complication. Secondary outcomes were perioperative mortality, any wound complication, any vascular complication, lymphatic complications, femoral/iliac stenosis, stroke, procedural duration, and hospital length of stay (LOS). A random effects model was performed.\u0000\u0000\u0000RESULTS\u0000A total of 5 studies with 2,038 patients were included. When compared with PC, patients who underwent SC showed a higher incidence of any access site complication (odds ratio [OR] = 3.09, 95% confidence interval [CI]: 1.87 to 5.10, P < 0.01), any wound complication (OR = 10.10, 95% CI: 3.31 to 30.85, P < 0.01), lymphatic complication (OR = 9.37, 95% CI: 2.15 to 40.81, P < 0.01), and longer procedural duration (standardized mean difference = 0.31, 95% CI: 0.12 to 0.51, P < 0.01). There was no significant difference between the 2 groups regarding perioperative mortality, any vascular complication, femoral/iliac stenosis, stroke, or hospital LOS.\u0000\u0000\u0000CONCLUSIONS\u0000The analysis suggests that surgical groin cannulation in MICS is associated with a higher incidence of any access site complication (especially wound complication and lymphatic fistula) and with a longer procedural time compared with PC. There was no difference in perioperative mortality.","PeriodicalId":80004,"journal":{"name":"Innovations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140713107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-05DOI: 10.1177/15569845241238999
Muhammad Ibrahim Azmi, A. Nair, Shahrul Amry Hashim
OBJECTIVE We evaluated the effectiveness of a consistent and structured self-practice coronary anastomosis program using a homemade low-fidelity beating-heart simulator. METHODS An intermediary trainee was subjected to an 8-week structured self-practice program. The program was divided into 2 parts of nonbeating and beating practices with a minimum number of timed anastomoses. Each part was followed by an assessment using an objective skills assessment tool score. The beating-heart simulator was built using motorized toy blocks connected wirelessly to a smartphone application. This was coded to enable rate selection. A junior consultant was compared to the subject at the end of the program. Both were tasked to perform 1 coronary anastomosis for both off-pump coronary artery bypass (OPCAB) and minimally invasive CAB (MICS) setup. The primary outcomes were anastomotic time and score compared with the junior consultant. Secondary outcomes were progression of anastomotic time and score throughout the program. RESULTS Overall performance of the studied subject approached the performance of the junior consultant in terms of time (OPCAB, 489 vs 605 s; MICS, 712 vs 652 s) and scores (OPCAB, 21 vs 20.7; MICS, 19 vs 20.6). There were inverse correlations between anastomosis time and number of practices for both nonbeating and beating anastomoses. Overall improvement was observed in terms of assessment scoring by 26.6%. CONCLUSIONS A structured self-practice program using an affordable and accessible simulator was able to help trainees overcome the MICS anastomosis learning curve quicker when introduced earlier. This may encourage earlier adoption of MICS among surgeons.
目的我们评估了使用自制的低保真心脏跳动模拟器进行连贯而有条理的冠状动脉吻合术自我练习计划的有效性。方法一名中级学员接受了为期 8 周的有条理的自我练习计划。该计划分为非搏动和搏动练习两部分，并规定了最低吻合次数。每个部分之后都使用客观技能评估工具进行评分。心脏跳动模拟器是利用与智能手机应用程序无线连接的电动玩具积木制作的。该程序已进行编码，以便选择速率。项目结束时，一名初级顾问与受试者进行了比较。两人的任务都是为体外循环冠状动脉搭桥术（OPCAB）和微创冠状动脉搭桥术（MICS）进行一次冠状动脉吻合术。与初级顾问相比，主要结果是吻合时间和得分。结果在时间（OPCAB，489 秒 vs 605 秒；MICS，712 秒 vs 652 秒）和分数（OPCAB，21 分 vs 20.7 分；MICS，19 分 vs 20.6 分）方面，研究对象的总体表现接近初级顾问的表现。在非搏动和搏动吻合中，吻合时间与练习次数呈反比。结论使用经济实惠、易于使用的模拟器进行结构化自我练习，能够帮助学员更快地克服 MICS 吻合术学习曲线。这可能会鼓励外科医生更早地采用 MICS。
{"title":"Self-Practice Program for Beating-Heart Minimally Invasive Coronary Anastomosis Using a Homemade Low-Fidelity Simulator: A Proof of Concept.","authors":"Muhammad Ibrahim Azmi, A. Nair, Shahrul Amry Hashim","doi":"10.1177/15569845241238999","DOIUrl":"https://doi.org/10.1177/15569845241238999","url":null,"abstract":"OBJECTIVE\u0000We evaluated the effectiveness of a consistent and structured self-practice coronary anastomosis program using a homemade low-fidelity beating-heart simulator.\u0000\u0000\u0000METHODS\u0000An intermediary trainee was subjected to an 8-week structured self-practice program. The program was divided into 2 parts of nonbeating and beating practices with a minimum number of timed anastomoses. Each part was followed by an assessment using an objective skills assessment tool score. The beating-heart simulator was built using motorized toy blocks connected wirelessly to a smartphone application. This was coded to enable rate selection. A junior consultant was compared to the subject at the end of the program. Both were tasked to perform 1 coronary anastomosis for both off-pump coronary artery bypass (OPCAB) and minimally invasive CAB (MICS) setup. The primary outcomes were anastomotic time and score compared with the junior consultant. Secondary outcomes were progression of anastomotic time and score throughout the program.\u0000\u0000\u0000RESULTS\u0000Overall performance of the studied subject approached the performance of the junior consultant in terms of time (OPCAB, 489 vs 605 s; MICS, 712 vs 652 s) and scores (OPCAB, 21 vs 20.7; MICS, 19 vs 20.6). There were inverse correlations between anastomosis time and number of practices for both nonbeating and beating anastomoses. Overall improvement was observed in terms of assessment scoring by 26.6%.\u0000\u0000\u0000CONCLUSIONS\u0000A structured self-practice program using an affordable and accessible simulator was able to help trainees overcome the MICS anastomosis learning curve quicker when introduced earlier. This may encourage earlier adoption of MICS among surgeons.","PeriodicalId":80004,"journal":{"name":"Innovations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140738354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-04DOI: 10.1177/15569845241239015
A. Abdelbar, A. Knowles, Joseph Zacharias
{"title":"Fourth Cardiac Procedure: Redo Endoscopic Mitral Surgery for a Stuck Leaflet.","authors":"A. Abdelbar, A. Knowles, Joseph Zacharias","doi":"10.1177/15569845241239015","DOIUrl":"https://doi.org/10.1177/15569845241239015","url":null,"abstract":"","PeriodicalId":80004,"journal":{"name":"Innovations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140741735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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